Hip and Knee Pain Treatments to Try Before Surgery

To diagnose a chronic condition, a physician will take a detailed history of your complaints, perform a thorough physical exam, and take appropriate X-rays. If you have arthritis -- the most common reason for joint replacement -- your doctors should take a conservative approach first. Surgery is a last resort and should be discussed only after you’ve tried all non-surgical options.

Joint replacements are mechanical and don't last forever. Even though we have progressed with modern techniques and new manufacturing methods, the average replacement hip or knee should only last for about 20 years. If you are 50 or younger that means another surgery in the future. It's for this reason we take a nonsurgical approach first.

Instead, try taking over-the-counter anti-inflammatory medication. These can be used on an as-needed basis or taken every day if that’s what you need for pain relief. If these stop working, then doctors will often suggest a prescription medication. Remember that all these medications have side effects, and you should consult your doctor before starting any drug regimen.

While you’re taking medication, also consider signing up for physical therapy. Physical therapy works in two ways. Arthritis causes a weakening of the muscles around the joint which in turn can increase pain. Therapy can increase muscle strength. Secondly, arthritis causes loss of motion and stiffness. The therapist can teach you stretching exercises to regain some of the range of motion. (Depending on your insurance coverage, you may need a prescription from your doctor for physical therapy.)

How Do You Choose a Joint Replacement Surgeon?

When medications and therapy just aren’t working for hip or knee pain, it’s time to choose a joint replacement surgeon. Find a surgeon who specializes in joint replacement surgery and who performs multiple procedures per week. Studies have shown a direct correlation between the number of joint replacement surgeries performed by the surgeon and the number of successful outcomes. In other words, surgeons get better with practice.

In addition, many orthopedic surgeons are specially trained in joint replacement surgery. A surgeon who has been through an orthopedic fellowship program usually has spent an extra year of training focusing specifically on joint replacement surgery. Ask your prospective surgeon about their credentials and about how many joint replacement surgeons they perform monthly. Verify the information independently through your state medical society, which should have that data available for public use.

Avoiding Joint Replacement Surgical Complications

What can you and your doctors do to ensure a successful surgery?

At Mount Sinai we do a test to see if our patients carry methicillin resistant staph aureus, or MRSA, which is a bacterium that can cause serious infections in patients who have undergone surgery.

As part of a pre-operative exam, doctors at Mount Sinai swab the inside of the patient's nose and sending it to a lab for processing. If a patient does carry MRSA, we treat them before surgery with a simple topical anti-bacterial ointment and avoid the infection altogether. It’s a simple step that can save a lot of time and money for the patient and the hospital.

Another method of avoiding surgical complications is to evaluate a diabetic patient’s A1C. The A1C is a simple blood test that tells us how well your diabetes is controlled. We’ve found that patients who have their condition under control have a much lower rate of post-operative complications. If this blood test shows they are not well controlled, we take the time to allow the primary care physician to work with the patient to modify their glycemic control to lower their A1C. The better you control your diabetes, the faster you heal.

Obesity is also an issue for people who want to undergo joint replacement surgery. People who are significantly overweight generally have a higher incidence of complications after an operation. Meet with a dietitian or nutritionist before surgery to develop a diet and exercise program that fits your needs.

After your operation, be proactive about your recovery. Follow your surgeon’s advice and take steps to ensure your safety and health. Then enjoy your new, more mobile, pain-free joint!

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